How do you manage citrate toxicity?
MANAGEMENT
- stop citrate administration.
- treat life-threatening hypocalcemia with IV calcium (either calcium gluconate or chloride)
- optimise cardiac output and liver function to enhance citrate clearance.
- consider RRT to correct metabolic derangement and enhance citrate clearance.
How do you treat citrate locks?
You have lots of options as to how you can fix it.
- Just give more calcium.
- Decrease the citrate dose.
- Slow the rate of citrate delivery by decreasing the blood flow rate.
- Run the circuit with no anticoagulation.
- Stop the dialysis altogether.
- Increase the patient’s resistance to citrate toxicity.
How is citrate cleared?
The chelated calcium and the citrate enter the filter and diffuse into the dialysis fluid where most of the citrate and calcium-citrate is removed. The calcium that is removed through the filter is replaced with a systemic infusion of calcium chloride to maintain normal systemic ionized calcium levels.
How do you test for citrate toxicity?
Citrate toxicity is likely when the ratio of total serum calcium to ionized calcium concentration exceeds 2.5, when both total and ionized calcium are measured in mmol/l or >10 if total calcium is measured in mg/dl [28].
Does citrate cause acidosis or alkalosis?
Due to citrate metabolism causes intracellular acidosis. As a result of intracellular acidosis compensation, decompensated metabolic alkalosis + respiratory acidosis and electrolyte imbalance may develop, blood transfusions may result in certain complications.
How does citrate cause metabolic acidosis?
In conclusion, there is an increase in carbon dioxide production as a result of citrate metabolism in non-massive, frequent blood transfusions; elevated carbon dioxide production causes intracellular acidosis; metabolic alkalosis + respiratory acidosis and electrolyte imbalance such as hypocalcemia, hypokalemia.
Does citrate bind to calcium?
Oral citrate therapy increases the urinary citrate levels, which in turn binds with calcium and inhibits the crystallisation thus reduces stone formation.
Does fresh frozen plasma have citrate?
The majority of citrate in whole blood products is present in fresh frozen plasma and platelets, not packed red blood cells.
What is the half life of citrate?
Approximately 18-20% of infused citrate remains unmetabolized and is excreted by the kidneys. In the presence of normal hepatic metabolism, the half-life of infused citrate is 36 ± 18 minutes.
How does citrate cause alkalosis?
How does citrate cause acidosis?
Which electrolyte imbalance may occur due to citrate?
What causes citrate toxicity in liver failure patients?
Metabolic acidosis. Patients with severe liver failure and lactic acidosis may have difficulty with citrate metabolism [25] and develop citrate toxicity, which is characterized by low systemic iCa ++, elevated total serum calcium, metabolic acidosis and an increased anion gap [26].
How to reduce citrate toxicity during LVL?
There is no single standard method to reduce citrate toxicity during LVL. One approach to this problem is to combine heparin administration with a reduced citrate infusion rate, thus limiting the amount of citrate returned to the donor while providing anticoagulation during apheresis.
Why is citrate bad for the human body?
Citrate toxicity is primarily a result of hypocalcaemia and metabolic effects of excess citrate.
How does citrate affect the ICA + + concentration?
The accumulation of citrate causes the systemic iCa ++ concentration to fall [27], whereas the bound fraction of calcium rises. If the calcium infusion is increased to correct the low iCa ++, most of the calcium is bound to citrate. A disproportional rise in total Ca occurs, while iCa ++ remains low.